Abstract：
BACKGROUND: Metformin exerts anti-inflammatory properties through a positive effect on oxidative stress, gut barrier integrity, and the gut microbiota. Our aim was to evaluate the influence of metformin on inflammatory bowel disease (IBD) outcomes in patients with type 2 diabetes mellitus (T2DM).
METHODS: We conducted a retrospective cohort study using the TriNetX database in patients with IBD and T2DM who initiated metformin vs oral hypoglycemics or insulin (control cohort) between August 31, 2002, and August 31, 2022. One-to-one propensity score matching was performed. Primary outcomes were need for intravenous (IV) steroid use or IBD-related surgery within 1, 2, and 3 years after metformin initiation.
RESULTS: Our cohorts included 1323 patients with ulcerative colitis (UC) (mean age 58.7 ± 12.2 years, 50.1% female, 77.3% White) and 1278 patients with Crohn\'s disease (CD) (mean age 56.3 ± 12.6 years, 58.2% female, 76.5% White). At 1 year, patients with UC and CD were less likely to require IV steroids (UC: adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.34-0.59; P < .01; CD: aOR, 0.67; 95% CI, 0.53-0.85; P < .01). The decreased need for IV steroids persisted in all metformin groups at 2 and 3 years. Patients with CD were at a lower risk for IBD-related surgery at year 1 (aOR, 0.5; 95% CI, 0.31-0.81; P < .01), and this finding persisted at 3 years (aOR, 0.62; 95% CI, 0.43-0.89; P < .01). Metformin did not affect risk for surgery in patients with UC.
CONCLUSIONS: Patients with IBD and T2DM on metformin had a decreased likelihood of worse IBD outcomes.
Our study shows that metformin is associated with decreased risk of corticosteroids in patients with ulcerative colitis and Crohn’s disease and decreased risk of surgery in patients with Crohn’s disease.
METHODS: We conducted a retrospective cohort study using the TriNetX database in patients with IBD and T2DM who initiated metformin vs oral hypoglycemics or insulin (control cohort) between August 31, 2002, and August 31, 2022. One-to-one propensity score matching was performed. Primary outcomes were need for intravenous (IV) steroid use or IBD-related surgery within 1, 2, and 3 years after metformin initiation.
RESULTS: Our cohorts included 1323 patients with ulcerative colitis (UC) (mean age 58.7 ± 12.2 years, 50.1% female, 77.3% White) and 1278 patients with Crohn\'s disease (CD) (mean age 56.3 ± 12.6 years, 58.2% female, 76.5% White). At 1 year, patients with UC and CD were less likely to require IV steroids (UC: adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.34-0.59; P < .01; CD: aOR, 0.67; 95% CI, 0.53-0.85; P < .01). The decreased need for IV steroids persisted in all metformin groups at 2 and 3 years. Patients with CD were at a lower risk for IBD-related surgery at year 1 (aOR, 0.5; 95% CI, 0.31-0.81; P < .01), and this finding persisted at 3 years (aOR, 0.62; 95% CI, 0.43-0.89; P < .01). Metformin did not affect risk for surgery in patients with UC.
CONCLUSIONS: Patients with IBD and T2DM on metformin had a decreased likelihood of worse IBD outcomes.
Our study shows that metformin is associated with decreased risk of corticosteroids in patients with ulcerative colitis and Crohn’s disease and decreased risk of surgery in patients with Crohn’s disease.
摘要：
背景：二甲双胍通过对氧化应激的积极作用发挥抗炎作用，肠道屏障完整性，和肠道微生物群。我们的目的是评估二甲双胍对2型糖尿病（T2DM）患者炎症性肠病（IBD）预后的影响。
方法：我们使用TriNetX数据库在2002年8月31日至2022年8月31日期间开始服用二甲双胍与口服降糖药或胰岛素（对照队列）的IBD和T2DM患者中进行了一项回顾性队列研究。进行一对一的倾向评分匹配。主要结果是在二甲双胍开始后1、2和3年内需要静脉（IV）类固醇使用或IBD相关手术。
结果：我们的队列包括1323例溃疡性结肠炎（UC）患者（平均年龄58.7±12.2岁，50.1%女性,77.3％的白人）和1278例克罗恩病（CD）患者（平均年龄56.3±12.6岁，58.2%女性，76.5%白色）。在1年,UC和CD患者需要静脉注射类固醇的可能性较小（UC：校正比值比[aOR]，0.45；95%置信区间[CI]，0.34-0.59；P<.01；CD：aOR，0.67；95%CI，0.53-0.85；P<0.01）。所有二甲双胍组在2年和3年时对静脉类固醇的需求下降。CD患者在第1年的IBD相关手术风险较低(aOR，0.5；95%CI，0.31-0.81；P<0.01），这一发现持续了3年(AOR，0.62；95%CI，0.43-0.89；P<0.01）。二甲双胍不影响UC患者的手术风险。
结论：服用二甲双胍的IBD和T2DM患者IBD结局恶化的可能性降低。
我们的研究表明，二甲双胍与溃疡性结肠炎和克罗恩病患者的皮质类固醇风险降低以及克罗恩病患者的手术风险降低相关。
方法：我们使用TriNetX数据库在2002年8月31日至2022年8月31日期间开始服用二甲双胍与口服降糖药或胰岛素（对照队列）的IBD和T2DM患者中进行了一项回顾性队列研究。进行一对一的倾向评分匹配。主要结果是在二甲双胍开始后1、2和3年内需要静脉（IV）类固醇使用或IBD相关手术。
结果：我们的队列包括1323例溃疡性结肠炎（UC）患者（平均年龄58.7±12.2岁，50.1%女性,77.3％的白人）和1278例克罗恩病（CD）患者（平均年龄56.3±12.6岁，58.2%女性，76.5%白色）。在1年,UC和CD患者需要静脉注射类固醇的可能性较小（UC：校正比值比[aOR]，0.45；95%置信区间[CI]，0.34-0.59；P<.01；CD：aOR，0.67；95%CI，0.53-0.85；P<0.01）。所有二甲双胍组在2年和3年时对静脉类固醇的需求下降。CD患者在第1年的IBD相关手术风险较低(aOR，0.5；95%CI，0.31-0.81；P<0.01），这一发现持续了3年(AOR，0.62；95%CI，0.43-0.89；P<0.01）。二甲双胍不影响UC患者的手术风险。
结论：服用二甲双胍的IBD和T2DM患者IBD结局恶化的可能性降低。
我们的研究表明，二甲双胍与溃疡性结肠炎和克罗恩病患者的皮质类固醇风险降低以及克罗恩病患者的手术风险降低相关。
